Digital Tools for Telehealth

Design a remote-care medical device that assesses whether a patient with cardiac heart failure (CHF) or chronic kidney disease (CKD) is hypervolemic (retains fluid) and integrate this digital tool within the existing checkup workflow for telemedicine.

Problem:: When the heart or kidney is not working, the body accumulates excess fluids in the blood. Water imbalances is a key indicator of poor heart or kidney management.

Opportunity:

Create a sensor-based tool to monitor changes in blood fluid level non-invasively and to detect weight gain

Background:

Chronic heart failure and chronic kidney disease are two of the most common chronic conditions. Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing prevalence of heart failure. Similarly, the overall prevalence of chronic kidney disease (CKD) increased significantly between 1999 and 2004. CHF and CKD present a tremendous burden on the healthcare system. Over 5 million people in the US have been diagnosed with CHF, resulting in 11 million office visits and 287,000 CHF related deaths annually. Over 660,000 Americans have CKD with 468,000 individuals requiring dialysis, which can cost $72,000 annually. In addition to direct healthcare costs, societal costs of advanced CKD include absenteeism, presenteeism, and premature death.  

Important considerations:

Medical

Take special consideration of the limitations of each indicator. For example, weight gain may be a result of increased adiposity as opposed to fluid retention. Similarly, low urine volume/day may be a result of decreased fluid intake. As a result, the device will most likely necessitate the development of an algorithm that will incorporate multiple measurements and contextual factors.

There are many clinical indicators of hypervolemia. Possible measurements for detecting volume overload include:

Behavioral/Social

-    Patients don’t like to be reminded that they are sick, they want to live a high quality of life with their condition.

-    Tracking and measuring—the quantified self—is what keeps them out of the hospital.

Resources

Key facts demonstrating the importance of fluid balance in common chronic conditions:

CHF

Renal Failure (Chronic Kidney Disease, CKD)

Sources:

  1. Blood Volume Determination, A Nuclear Medicine Test in Evolution, Margouleff, Donald MD, FACP
  2. https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults?source=search_result&search=chronic%20kidney%20disease%20FLUID%20OVERLOAD&selectedTitle=1~150
  3. https://www-ncbi-nlm-nih-gov.ezproxy.med.nyu.edu/pubmed/25177700
  4. https://www.ncbi.nlm.nih.gov/pubmed/27475662
  5. http://www.modernhealthcare.com/article/20141011/MAGAZINE/310119932
  6. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
  7. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159335